Cardiac‐specific experiential avoidance predicts change in general psychological well‐being among patients completing cardiac rehabilitation

Abstract

Previous studies have shown that experiential avoidance (EA) is associated with physical and psychological wellbeing in medical and non-medical samples. The aims of the present study were to evaluate the reciprocal association between psychological well-being and EA over time among cardiac rehabilitation (CR) patients with moderately to severely low levels of psychological well-being. Pre-CR data on demographic characteristics, measures of psychological well-being, and cardiac-specific EA were collected from 915 CR patients, as well as post-CR psychological wellbeing and EA data, from 800 of these patients. A crosslagged model was estimated to examine the relationship between EA and psychological well-being among patients with moderately to severely low levels of psychological well-being based on questionnaire scores. Both EA and psychological well-being significantly changed during CR and were negatively associated with each other at both preand post-CR. Results from cross-lagged structural equation modeling supported a nonreciprocal association between EA and psychological well-being during CR. Pre-CR assessment of EA in patients showing low levels of wellbeing at the beginning of CR could help to identify patients

Mobile assessment of experiential avoidance, mood, stress, and attendance in cardiopulmonary rehabilitation.

“…Although, high variance was observed in the association between EA and stress (s = .361), indicating that lower EA could predict higher next-day stress for some participants on some days. Overall, these findings did align with a recent study supporting a nonreciprocal relationship between EA and psychological well-being (i.e., higher EA pre-CR predicting post-CR poorer psychological well-being-but not in the opposite direction; Spatola et al, 2021). It is possible that differences in findings compared with previous research are related to choice of assessment windows and lagged time (from one EMA to the next within a day vs. dayto-day), or perhaps these relationships look different among college students compared with CVPR patients.…”

“…However, the incorporation of evidence-based psychosocial interventions in standard CVPR care remains suboptimal. Results from this study further supports the need to evaluate process-based interventions that target EA (e.g., ACT) in CVPR; one randomized-controlled trial evaluating an ACT intervention in CR is currently nearing completion (ACTonHEART; Spatola et al, 2021). Future studies should also examine the dynamic role of EA, mood, and stress among different subsets of CVPR patients, such as those who meet diagnostic criteria for depression and anxiety disorders.…”

“…They also found that cardiac-specific EA was inversely associated with improved exercise endurance. A more recent study replicated these findings and supported a nonreciprocal relationship between EA and psychological well-being from pre-to post-CR, supporting hypotheses that EA is a mechanism driving changes in psychological well-being (Spatola et al, 2021). EA has not been associated with attendance rates (i.e., the proportion of insurance approved CR sessions attended) in past studies; however, measurement of EA has been limited to pre-and postassessment (Goodwin and Emery, 2016).…”

“The heart in a bag”: The lived experience of patient-caregiver dyads with left ventricular assist device during cardiac rehabilitation

“…At the same time, the success of the intervention could generate feelings of hope for the future and for the expectation of the new heart. In fact, as has already been demonstrated in cardiac patients, the CR could serve as a vehicle for motivation and persuasion as well as a critical point for tracking the cardiac patients’ quality of life, in both the presence and absence of significant psychological distress ( Pietrabissa et al, 2017 ; Spatola et al, 2018 , 2021 ).…”

“Cardiotoxic” and “cardioprotective” partner support for patient activation and distress: Are two better than one?

“…K E Y W O R D S cardiac disease, couple relationship, distress, partner support, patient activation, patient engagement Despite increasing survival rates and prolonged life expectancy, cardiac diseases, especially their acute manifestations, still represent important causes of death and disability. Cardiac disease contributes to patients' mood disorders, such as depression and anxiety (Cohen et al, 2015;Protogerou et al, 2015;Spatola et al, 2018Spatola et al, , 2021, which are significant risk factors for poor prognosis and adherence to medical recommendations, high mortality, and low quality of life (Alvarenga & Byrne, 2016). Although there has been much research on individual psychological outcomes after an acute cardiac event, some studies have started to underline the relational nature of the disease, exploring how the quality of partner support is associated with patient outcomes.…”